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MEDICATION REVIEW SERVICES

GUIDELINES FOR PHARMACISTS

VERSION 1.0

ISSUE DATE: APRIL 1, 2011

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Table of Contents OVERVIEW..................................................................................................................................................... 3 1. Medication Review Standard ............................................................................................................. 3 2. Medication Review Pharmacist Consultation .................................................................................... 3 3. Medication Review Follow-up........................................................................................................... 3 GENERAL TERMS AND CONDITIONS ............................................................................................................. 4 Patient eligibility ....................................................................................................................................... 4 Service provision ....................................................................................................................................... 4 Payment for services ............................................................................................................................. 4 Documentation ......................................................................................................................................... 5 Claims for payment submission ................................................................................................................ 5 PharmaNet response code for medication review claims .................................................................... 5 TERMS AND CONDITIONS FOR INDIVIDUAL SERVICES ................................................................................. 6 1. Medication Review Standard ............................................................................................................. 6 Patient eligibility ................................................................................................................................... 6 Activities ................................................................................................................................................ 6 Required documentation ...................................................................................................................... 7 Claims for payment ............................................................................................................................... 7 Claims restrictions................................................................................................................................. 7 2. Medication Review Pharmacist Consultation .................................................................................... 8 Patient eligibility ................................................................................................................................... 8 Activities ................................................................................................................................................ 8 Required documentation ...................................................................................................................... 8 Claims for payment ............................................................................................................................... 9 Claims restrictions................................................................................................................................. 9 3. Medication Review Follow-Up ......................................................................................................... 10 Patient eligibility ................................................................................................................................. 10 Activities .............................................................................................................................................. 10 Required documentation .................................................................................................................... 10 Claims for payment ............................................................................................................................. 11 Claims restrictions............................................................................................................................... 11 SERVICES ASSOCIATED WITH PALLIATIVE CARE.......................................................................................... 12 TEMPLATES AND GUIDES ON THE PHARMACARE WEBSITE ....................................................................... 12

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OVERVIEW The objective of the B.C. Medication Review Services program is to increase communication between patient and pharmacist to promote safe and effective medication use and improve health outcomes. Although not a new scope of practice for community pharmacists, this program standardizes how these clinical pharmacy services are delivered across B.C. There are three levels of Medication Review Service: 1. Medication Review Standard (MR-S) 2. Medication Review Pharmacist Consultation (MR-PC) 3. Medication Review Follow-Up (MR-F) 1. MEDICATION REVIEW STANDARD This patient-care service is provided by a pharmacist through an in-person private appointment. The pharmacist meets with the patient to gather all pertinent information to prepare a best possible medication history (BPMH). Medications are reviewed in order to improve the patients understanding of their medications, including what medications they are taking, why they are taking them, and how best to take them. The pharmacist will create a current medication list (including vitamins, herbal products, and over-thecounter medication) for the patient. This list can also be used by other health care professionals and caregivers. The fee for a MR-S ($60) may be claimed to a maximum of once per patient every 6 months. 2. MEDICATION REVIEW PHARMACIST CONSULTATION When a medication management issue (MMI) is identified by a pharmacist as a result of a MR-S, the pharmacist will work with the patient to resolve the issue. If appropriate, the pharmacist will notify (and if necessary, collaborate with) the most responsible prescriber about the MMI, the care plan, and the results achieved. Resolving the MMI raises the Medication Review type from Standard to Pharmacist Consultation. The fee for a MR-PC ($70) service may be claimed to a maximum of once per patient every 6 months. 3. MEDICATION REVIEW FOLLOW-UP This pharmacy service is for people who have already received a complete MR-S or MR-PC and require follow-up due to a subsequent medication change, or

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are having difficulty understanding their medication and require further follow-up as part of their care plan, or require follow-up to implement and/or evaluate the action plan for resolving a medication management issue

The pharmacist will update the BPMH with the new information, ensure patient understanding of the change(s), and provide the patient with a new, current medication list. The fee for the MR-F service ($15) may be claimed to a maximum of 4 times per patient per year. GENERAL TERMS AND CONDITIONS PATIENT ELIGIBILITY To be eligible to receive any of the three Medication Review services, the patient must be British Columbia resident, and have a B.C. Personal Health Number (PHN), and require at least one medication 1, and give informed consent to receive the service.

If a patient who is a B.C. resident does not have a PHN, the pharmacist may issue them one in the usual fashion and, as long as they meet the other requirements, the patient will then be eligible to receive a Medication Review. SERVICE PROVISION All three types of review must be: provided as an in-person appointment with a pharmacist (and not by telephone or any other electronic means), provided in a suitable area that is respectful of the patients right to privacy, and properly documented.

PAYMENT FOR SERVICES Pharmacies must not request or accept any additional fees or payments from any patient or third party payer in relation to medication reviews for which clinical service fees will be claimed, or have been claimed, from the Province.

A medication that is entered into PharmaNet

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DOCUMENTATION Documentation is a required element of all patient care services and must comply with the Framework for Professional Practice and relevant Professional Practice Policies (College of Pharmacists of BC) and relevant privacy, storage and security standards as legislated by the Health Professions Act. Records must be maintained and accessible on-site at the pharmacy for 3 years as required by both PharmaCare (for audit purposes) and the College of Pharmacists of BC (for audit and standards of practice purposes). Specific documentation requirements are provided in the Criteria for Individual Services section. CLAIMS FOR PAYMENT SUBMISSION

Claims for Medication Review Services (Standard, Pharmacist Consultation or Follow-up) must be submitted electronically via PharmaNet on the date of the Medication Review, using the appropriate PIN code.
To submit a claim for Medication Review Services: in the Days Supply field, enter 1 in the Quantity field, enter 1 in the Drug Cost field, enter 0 in the DIN/PIN field, enter the appropriate PIN

PINs are provided in the Terms and Conditions for each type of review. Pharmacists may want to consult with their software vendor to determine if there are other requirements for payment reconciliation. Note: Remember to enter zero in the Drug Cost field to ensure that the fee does not inadvertently appear on the patients receipt. PHARMANET RESPONSE CODE FOR MEDICATION REVIEW CLAIMS Claims for Medication reviews are processed in batches on a monthly basis rather than being adjudicated in real-time on PharmaNet. When you submit a claim for a Medication Review, PharmaNet will return a CD - patient not entitled to drug claimed response. The real-time adjudication message of patient not entitled to drug claimed DOES NOT APPLY AND SHOULD BE IGNORED.

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You do not need to reverse these claims or re-submit. If you entered the data in the requested fields, the claims will be processed for payment. TERMS AND CONDITIONS FOR INDIVIDUAL SERVICES 1. MEDICATION REVIEW STANDARD PATIENT ELIGIBILITY To be eligible to receive a Medication Review - Standard (MR-S), patients must meet the criteria set forth in the Patient Eligibility section above. ACTIVITIES The Medication Review Standard (MR-S) service is an in-person appointment with a pharmacist provided in a suitable area that respects the patients right to privacy. The focus of the MR-S is to: 1. Enable the pharmacist to gather information to prepare a best possible medication history (or BPMH). 2. Improve patient understanding about their medications. 3. Have the pharmacist create a current medication list for the patient. This list can also be used by other health care professionals and caregivers. During the appointment, the pharmacist and patient review the patients medications 2 and prepare a list of current medications so the patient is aware of: what medications they are taking, why they are taking them, and how best to take them (i.e., times, special instructions and warnings).

Note: If the standard Medication Review session reveals a medication management issue (MMI), the pharmacist may follow up on the issue and claim the fee for a Medication Review Pharmacist Consultation (MR-PC).

Including prescription, over-the-counter medicines, herbal medicines and vitamins.

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REQUIRED DOCUMENTATION Documentation of a MR-S must include all of the following: expressed verbal patient consent , pharmacist name (or supervising pharmacist if review is completed by pharmacy student or intern), date of service, any relevant notes for continuity of care, and a copy of the current medication list prepared during the appointment (see the Current Medication List template provided on the PharmaCare website)

CLAIMS FOR PAYMENT The pharmacist can submit a claim to PharmaCare for a $60 MR-S fee. 3 The claim must be submitted electronically via PharmaNet on the date of the review session, using the appropriate PIN code. For details, see the Claims Submission section above.

PIN
99000501

Description
Medication Review Standard (MR-S)

Payment Amount
$60.00

CLAIMS RESTRICTIONS For eligible patients, pharmacists may claim either one Medication Review Standard (MR-S) or one Medication Review Pharmacist Consultation (MR-PC) fee (but not both) to a maximum of once per patient every 6 months. For pharmacies involved in the B.C. Medication Management Project, pharmacists may bill for either a Medication Management Service or a Medication Review Service, but not both. The Resident Medication Review provided to residents of long-term care facilities and described in the Residential Care Facilities and Homes Standards of Practice (College of Pharmacists of BC), is not eligible for a MR-S fee as it is already funded through the PharmaCare Plan B payment structure.

Consistent with the fee payable for a Level 1 Full Work-up Contact in the BC Medication Management Project.

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2. MEDICATION REVIEW PHARMACIST CONSULTATION PATIENT ELIGIBILITY To be eligible to receive a Medication Review Pharmacist Consultation (MR-PC), patients must: be eligible to receive a Medication Review (see Patient Eligibility requirements above), and have had a medication management issue (MMI) (also referred to as a drug related problem or drug therapy problem) identified during the course of a Medication Review - Standard.

ACTIVITIES The Medication Review Pharmacist Consultation (MR-PC) service is an in-person appointment with a pharmacist provided in a suitable area that respects the patients right to privacy. It is undertaken only when a medication management issue (MMI) has been identified by a pharmacist during an MR-S. The focus of the MR PC is the same as the Medication Review Standard with the added focus on: 1. identifying and resolving one MMI 4, and if applicable, 2. notifying (and, if necessary, collaborating with) the most responsible physician or other prescriber about the MMI, the care plan and the results achieved. During the appointment, the pharmacist and patient work together to: identify the MMI , prepare a care plan to resolve the MMI, implement the care plan, and evaluate results.

REQUIRED DOCUMENTATION Documentation of a MR PC must include: expressed verbal patient consent, pharmacist name (or supervising pharmacist if review is completed by pharmacy student or intern), date of service, MMI details documented on the Medication Review Pharmacist Consultation form ( see the Medication Review Pharmacist Consultation template available on the PharmaCare website),

The seven types of medication management issues include: unnecessary drug; needs additional drug; ineffective drug; dosage too low; adverse drug reaction; dosage too high; and patient unable to self-manage.

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any relevant notes for continuity of care (medication involved, specifics of plan, follow up details), a copy of the current medication list prepared during the appointment (see the Current Medications List template available on the PharmaCare website), and, if applicable, details of communications with most responsible physician or other prescriber, including their involvement in the MMI care plan (if necessary).

CLAIMS FOR PAYMENT The pharmacist can submit a claim to PharmaCare for a $70 MR-PC fee. 5 The claim must be submitted electronically via PharmaNet on the date of the review session, using the appropriate PIN code. For details, see the Claims Submission section above.

PIN
99000502

Description
Medication Review Pharmacist Consultation (MR-PC)

Payment Amount
$70.00

CLAIMS RESTRICTIONS For eligible patients, pharmacists may claim either one Medication Review Standard (MR-S) or one Medication Review Pharmacist Consultation (MR-PC) fee (but not both) to a maximum of once per patient every 6 months. For pharmacies involved in the B.C. Medication Management Project, pharmacists may bill for either a Medication Management Service or a Medication Review Service, but not both. Clinical service fees related to adapting or renewing prescriptions cannot be claimed in conjunction with an MR-PC. Where a medication management issue has been resolved by an action that has a separately defined service fee (e.g., administration of injections and/or adaptations of prescriptions), the pharmacist may claim either the MR-PC fee or the separately defined service fee, but not both. The MR-PC is not billable for patients in long-term care facilities receiving services funded through the PharmaCare Plan B payment structure.

Consistent with the fee payable for a Level 2 Full Work-up Contact in the BC Medication Management Project

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3. MEDICATION REVIEW FOLLOW-UP PATIENT ELIGIBILITY To be eligible to receive a Medication Review Follow-Up (MR-F), patients must: have already received a complete Medication Review Standard (MR-S) or Medication Review Pharmacist Consultation (MR-PC), require follow-up due to a subsequent medication change 6, and give informed consent to receive the service.

ACTIVITIES The Medication Review Follow-Up (MR-F) service is an in-person appointment with a pharmacist provided in a suitable area that respects the patients right to privacy. The focus of the MR-F is to: 1. update the best possible medication history with new information; 2. review, correct or update patient understanding about their medications in situations where medications have changed or patients are having difficulty understanding their medications ; 3. update and create a new, current medication list. This list can also be used by other health care professionals and caregivers. During the appointment, the pharmacist and patient review the patients medications so the patient is aware of: what medications they are taking, why they are taking them, how best to take them (i.e., times, special instructions and warnings).

REQUIRED DOCUMENTATION Documentation of a MR-F must include: expressed verbal patient consent , pharmacist name (or supervising pharmacist if review is completed by pharmacy student or intern), date of service, a copy of the updated medication list prepared during the appointment,

Change to a medication entered in PharmaNet

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any relevant notes for continuity of care (medication involved, specifics of plan, follow up details)

CLAIMS FOR PAYMENT The pharmacist can submit a claim to PharmaCare for a $15 MR-F fee. 7 The claim must be submitted electronically via PharmaNet on the date of the review session, using the appropriate PIN code. For details, see the Claims Submission section above.

PIN
99000503

Description
Medication Review Follow-Up (MR-F)

Payment Amount
$15.00

CLAIMS RESTRICTIONS For eligible patients, the MR-F fee may be claimed to a maximum of 4 times per patient per year. Only one of either the Medication Review Standard (MR-S), Medication Review Pharmacist Consultation (MR-PC) fee or Medication Review Follow-Up can be claimed for each service episode. For pharmacies involved in the BC Medication Management Project, pharmacists may bill for either a Medication Management Service or a Medication Review Service, but not both. Follow-ups associated with a Resident Medication Review provided to residents of long-term care facilities and described in the Residential Care Facilities and Homes Standards of Practice (College of Pharmacists of BC), are not eligible for a MR-F fee as they are already funded through the PharmaCare Plan B payment structure.

Consistent with the fee payable for a Level 1 Follow-Up Contact in the BC Medication Management Project

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SERVICES ASSOCIATED WITH PALLIATIVE CARE Plan P patients in hospice and at home 8 are eligible for the same B.C. Medication Review Services as other eligible B.C. residents, including: 1. Medication Review Standard 2. Medication Review Consultation 3. Medication Review Follow-up Discussions are continuing around remuneration for clinical services for Plan P.

TEMPLATES AND GUIDES ON THE PHARMACARE WEBSITE Title Current Medication List template Medication Review Pharmacist Consultation template Medication Review Services Guidelines for Pharmacists (this guide) URL www.health.gov.bc.ca/pharmacare/pcist/medlisttemplate.doc http://www.health.gov.bc.ca/pharmacare/pcist/mmitemplate.doc www.health.gov.bc.ca/pharmacare/pdf/medrevguide.pdf

Home is defined as wherever the person is living, whether in their own home, with family or friends, in a supportive living residence or in a hospice that is not covered under PharmaCare Plan B.

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